Pre-diabetes is defined as a fasting blood glucose level greater than 100 mg/dL or a hemoglobin A1c above 5.7%. While it may sound benign, pre-diabetes is not a harmless laboratory finding—it is an early disease state and a major warning sign. It represents the pathway toward type 2 diabetes and is strongly associated with premature heart disease, stroke, peripheral vascular disease, and dementia.
Equally concerning are the downstream consequences: escalating medication use, frequent medical visits, and rising healthcare costs that often follow once diabetes becomes established.
Pre-diabetes is extraordinarily common. Approximately 38% of all Americans meet the criteria, and the prevalence rises to nearly 50% in adults over the age of 65. Many people are unaware they have it.
Individuals at highest risk: those who are overweight—particularly with excess abdominal fat—physically inactive, or with a family history of diabetes. Additional risk factors include polycystic ovary syndrome, fatty liver disease, obstructive sleep apnea, chronic sleep deprivation, night-shift work, a history of gestational diabetes, or delivering a baby weighing more than nine pounds. Anyone with these risk factors should be screened, at a minimum, with a hemoglobin A1c test, which a physician can easily order.
Pre-diabetes is reversible. That’s the good news. Lifestyle change is powerful medicine. Regular physical activity—even simple daily walking—improves insulin sensitivity, meaning the body requires less insulin to control blood sugar. Less insulin demand translates into better health.
Diet also matters—not just what you eat, but when and how you eat it. Consuming more calories earlier in the day and reducing carbohydrate-heavy meals later can significantly improve glucose control. Pairing carbohydrates with protein or fiber slows absorption and blunts glucose spikes.
Continuous glucose monitoring (CGM) is one of the most promising tools in this space. These small patches, worn on the arm, measure glucose every few minutes and transmit it to a smartphone. What makes CGM technology so valuable is its ability to reveal individual variability—different people respond very differently to the same foods.
Personal example: Eating a banana alone raised my blood sugar to 165 mg. Eating that same banana after cottage cheese—a protein-rich, slowly digested food—kept my glucose under 110. Interestingly, when my friend tried a banana, his blood sugar barely changed. This level of personalization is nearly impossible without actual data.
Continuous glucose monitors are now available over the counter, though insurance will not cover them unless a patient already has insulin-dependent diabetes. Unfortunately, our healthcare system often prioritizes treating disease over preventing it. Go figure.
Dr. Charlie Barnett is a contributor to KnoxTNToday, where he writes a weekly column, DocTalk, sharing his expertise on health and wellness management.
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